A moldy mattress, a broken handrail, a dirty toilet, mildew in the shower, and a bathroom door that didn’t close all the way were among the unsanitary and unsafe conditions found last year during inspections of 30 group homes for foster children in Massachusetts, according to a federal audit released Monday.

The audit, by the Department of Health and Human Services’ Office of Inspector General, concluded that 27 of the 30 homes inspected failed to follow health and safety standards designed to protect children taken into state custody due to abuse or neglect.

In addition, 18 of the 30 group homes had one or more employees who had not completed the required criminal background checks.

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“When you see the issues we’ve identified in the report, it is concerning,” said George Nedder, assistant regional inspector general for New England, who helped conduct the audit in May 2016, nearly a year-and-a-half after Governor Charlie Baker hired a new commissioner to rebuild the troubled Department of Children and Families. “America needs to ask: Is this really acceptable for our children to live in?”

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State education and child welfare officials said Monday that they have already worked with the private contractors that run the group homes to fix the problems identified in the audit.

“Children in our custody deserve a safe and healthy environment, and the specific issues identified during the course of the audit were immediately addressed by the Department of Education and Care and Department of Children and Families staff, who accompanied the auditors on their visits to the group homes,” said Andrea Grossman, a DCF spokeswoman.

She said both state agencies have agreed to meet four times a year with providers “to identify and correct licensing issues, program quality, and operational concerns as quickly as possible.”

Massachusetts has 101 group homes for foster children as young as 4. The privately run, state-licensed facilities are generally considered the placement of last resort for abused and neglected children with significant behavioral or mental health needs.

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When the Department of Children and Families removes children from their homes, it seeks to place them first with relatives and then with foster parents, if possible, because group homes are considered more expensive and less nurturing.

But as Massachusetts has removed more children from their homes due to the opioid crisis, and the state has struggled to recruit new foster parents, the group homes have taken on more abused and neglected children, advocates said.

According to the most recent data available, 821 children, or 9 percent of all foster children in the state, were living in group homes in March 2017. That is a slight increase from March 2015, when 754 children, or 8 percent of all foster children, were in group homes.

“Our concern right now is that the system still has an overreliance on out-of-home placement, and that overburdens the whole system and trickles down to the programs that are designed for children with the highest level of need,” said Naoka Carey, executive director of Citizens for Juvenile Justice, which advocates for youth in the child welfare and criminal justice systems.

The audit did not identify the contractors that run the group homes where violations were found. The Globe filed a public records request asking for the names of the contractors but was told by federal officials the information would not be immediately released.

‘There needs to be a timely response so children are living in an environment that promotes a feeling of safety, a feeling of security, and of being valued.’

— Mary A. McGeown, Massachusetts Society for the Prevention of Cruelty to Children executive director

The report, however, included photographs of broken dressers with missing drawers, a hole in a bedroom wall, a dirty pillow, a ripped mattress, a rusty bathroom stall, and other code violations.

The audit also said 155 of the 1,445 employees who work at the 30 homes had not undergone all of the required criminal background checks.

“For me, the most serious incidence was the delay in getting criminal background checks completed,” said Maria Z. Mossaides, who heads the state Office of the Child Advocate.

As for the broken furniture and dirty conditions, “The question I have is how long did those conditions exist before they were remedied by the providers?” she said.

The audit said the problems were uncovered even though the state Department of Early Education and Care, which licenses and inspects group homes, had performed the required onsite checks. But those department’s visits are announced, giving private providers time to clean up and make repairs before inspectors show up, Nedder said.

The federal audit recommended that the state conduct unannounced visits; that it consider contractually requiring providers to make repairs on a specific timeframe; and that it tighten internal controls to ensure that criminal background checks are completed.

In a joint response included in the audit, DCF and the Department of Early Education and Care said they agreed with the policy recommendations.

Mary A. McGeown, executive director of the Massachusetts Society for the Prevention of Cruelty to Children, said the conditions in the homes must be fixed, given the trauma children experience when they are removed from their families and placed in a group setting.

“There needs to be a timely response so children are living in an environment that promotes a feeling of safety, a feeling of security, and of being valued,” McGeown said. “Clearly, the audit revealed areas of significant concern where we’re falling short.”